Provider Demographics
NPI:1598782062
Name:WADE, CARLOS (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:WADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 COUNTRY VISTA CIR
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7877
Mailing Address - Country:US
Mailing Address - Phone:325-716-9182
Mailing Address - Fax:817-568-5423
Practice Address - Street 1:139 COUNTRY VISTA CIR
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7877
Practice Address - Country:US
Practice Address - Phone:325-716-9182
Practice Address - Fax:817-568-5423
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4631207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183303001Medicaid
TX8V9831OtherBLUE CROSS
TX8G7396Medicare PIN
TXP00367861Medicare PIN
TX183303001Medicaid